Bacterial conjunctivitis

What it is

Bacterial conjunctivitis in the neonate has its own name, ophthalmia neonatorum, because its organisms and its treatment are not those of the older child or adult.

Causes and risk

In the neonate the common causative organisms are Neisseria gonorrhoeae and Chlamydia trachomatis, and the timing after birth tells them apart:

• Within 2 to 5 days after birth: N. gonorrhoeae, causing a hyperacute, severe conjunctivitis
• After 5 to 14 days: C. trachomatis, the more common cause but less aggressive

Bacterial infection in older children or adults is often strep or staph. Common agents include S. aureus, S. pneumoniae, H. influenzae and M. catarrhalis. N. gonorrhoeae belongs here too: it must be considered in neonates or if the patient is sexually active, because it invades the cornea to cause keratitis. History: vaginal discharge in the mother in ophthalmia neonatorum.

How it presents

Bilateral generalized congestion with copious purulent discharge, lid swelling, papillae, conjunctival injection and chemosis. VA is not affected when the discharge is cleaned, unless the cornea gets affected, which is rare in general but common with ophthalmia neonatorum.